pre-conceptional counselling and pre-conceptional care2

8/6/2019 Pre-conceptional Counselling and Pre-conceptional Care2

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PRE-CONCEPTIONALCARE &PRE-CONCEPTIONALCOUNSELLING

GUIDED BY:MRS.VINITHA SURESHMISS SUSHMA

PRESENTED BYDEEPA KUSHWAHADIVYA MATHEW


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INTRODUCTION

Concept of preconceptioncare has evolved over thelast several decadesJ.W. Ballantyne -

originated concept of pre-conception care andcounseling.


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CONTu

Ideally a pregnancy should be by choice and not by chance and by

appointment and not by accident.Preparing for pregnancy is a positivestep towards enhancing pregnancyoutcome and provides prospective

parents with options that may not beavailable once a pregnancy is confirmed.


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DEFINITIONPre-conception counselling (also

called pre-conceptual counselling)

is based on the medical theory thatall women of child-bearing yearsshould be pre-screened for healthand risk potentials before

attempting to become pregnant.Pre-conceptional counselling ispreventive medicine for obstetrics.


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THE VISION OF PRE-

CONCEPTION CARE All pregnancies areplanned

All risks areidentified A comprehensiveplan is available toassist women inmaking healthylifestyle choices topromote a healthypregnancy


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Cont.

A team of physicians, healthcare coordinators, mental health

specialists and nutritionists canguide a woman along thecontinuum


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OBJECTIVE To ensure that a woman enterspregnancy with an optimal state

of health which would be safe bothto herself and the fetus


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GOAL OF PRECONCEPTION

COUNSELLING AND CARETo identify pre-existing conditions

that may affect an anticipated

pregnancyTo Identify processes involving

mother and fetus


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Cont. To Screen for conditions which may

impact fertility, fetal development ormothers ability to adapt to pregnancy

Institute preventative measures beforepregnancy

Educate couples regarding risks of

pregnancy and strategies to minimizethe risks


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COMPONENTS OF

PRECONCEPTION CAREIt begins with attitudes andpractices that value pregnant

women children and families.It encourages women and men toprepare actively for pregnancy.

It focuses on environmentinfluencing the family.

It respects the diversity of peopleslives and experiences.


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ContIt incorporates informed choice.It enables women and men to be as

healthy as possible helping them torecognize actual and potentialproblems.

It attempts to identify parents with

increased genetic risk.It helps to provide them sufficientknowledge about reproductiveoptions.


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STATISTICS

Worldwide maternal mortalityapproximately one million women

annuallyMaternal mortality rate in India

is 460 deaths/1 lakh live birthpopulationOrissa has the highest rate of

MMR i.e. 781/1000 live birthKerala has least 76/1000 live birth


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WHY PRE-CONCEPTION C&C

Increased utilization of prenatalcare, no decrease in MM, LBW.

1stprenatal visit maybe too late Limits of prenatal care recognizede.g.

- Organogenesis begins early. NTclosure- 6 weeks(28 days post

conception) Too late for folic acidbenefit- Placental dev. (7 days post

conception) Poor placental dev.- pre-eclampsia, preterm labor


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PLACE OF PRE-CONCEPTION

CARE WORK PLACE SCHOOL

MEDIA PRIMARY CARE COMMUNITY SETTING


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RISK ASSESSMENT AND

EDUCATIONIdentification of high risk factors forpregnancy.

Counseling for patient with bad

pregnancy history.Risk from the environment.DietFolic acid

Body weightExerciseSmoking


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Cont

Alcohol use Medication review Illicit drug use Cervical screening

Chronic diseases Infections


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IDENTIFICATION OF HIGH

RISK FACTORS FORPREGNANCY A detailed interview should be taken. Basic health status should be

assessed. Immunization should be taken by

women. Fear should be removed by

counseling.


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Cont.

Verify if the women has takenany drug and educateaccordingly.

They should be urged to stopsmoking.Start taking folic acid 4 weeks

prior to conceptions.


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COUNSELING FOR PATIENT

WITH BOH.

Discuss the importance of prenatal diagnosis of chromosomal diseases.

A couple having previous history of

abortion or fetal loss should beconvinced and counseled. Identify-

- existing or emerging illness whichmay have gone undetected before.

- existing risk for the woman whomay become pregnant.

- existing risk which may affect afetus if the woman become pregnant.


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RISK FROM ENVIRONMENT

Consider potential hazards at home or at work place.

Advice to wash hands after gardening or to avoid cleaningcow dung during pregnancy to avoid toxoplasmosis.

Advice the woman to avoid for exposure to any hazardous substances radiation etc. who is planning to become pregnant.


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DIET Advice to take a balanced diet along

with eating five portions of fruits andvegetables per day.(paneer, curd, softcheese).

Consuming dairy products to raisedstores of vitamin, iron and calcium.

Vitamin D should be

included in the diet(10 mcg/day) along

with folic acid and

vitamin C.


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Cont

She should be advised toavoid

- uncooked meat, fish

and eggs.- unpasteurized milk.- soft cheese.

- unwashed fruits andvegetables.- caffeine and heavy

soft drinks.


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FOLIC ACID

All women should takeatleast 400 mcg per

day, if she is planningto become pregnant and for atleast the 1st

three months of

pregnancy to reducethe risk of NTD.


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BODY WEIGHT

Women with overweight should beadviced to lose weight.

Women who are underweight should beadviced to gain weightbefore getting

pregnant. Consultation with the

dietician may behelpful.


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Exercise

Advice the women toexercise regularly.


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ALCOHOL USE

High level of alcohol usecauses fetal alcohol syndrome(FAS).

Advice women to avoidalcohol completely. When a women is

unable to reduce her

alcohol consumption with support in primary care, offer specialist referal.


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MEDICATION REVIEW

Minimize exposure to all drugs including those bought over the

counter. Avoid all herbal preparations

during pregnancy. Advice not to exceed 10,000 IU of

vitA.


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ILLICIT DRUG USE

Avoid coccaine. Opiate use should be avoided.

Effect of Cannabis is harmful for thefetus.


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CERVICAL SCREENING

Encourage the women to go forcervical screening before

pregnancy.


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CHRONIC DISEASES

Women should have theoppurtunity to discuss the risk ofchronic diseases on the pregnancyand make a choice how to optimizetheir health , disease control andmedications prior to conceptions.

Encourage the women to usecontraceptives regularly until theyhave a full review with thespecialist team.


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Cont

Asthma Diabetes

Chronic hypertension Heart diseases Epilepsy

Thyroid diseases Mental health problems


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INFECTIONS

Rubella Viral hepatitis

Varicella TORCHES


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AGE RELATED RISKS

As the maternal age increase therisk for fetal abnormality

increases. E.g. down syndrome. 1 in 1500 risk at 20 years 1 in 270 at 35 years 1 in 100 at 40 years


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PRE-CONCEPTIONAL

COUNSELING


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PRE-CONCEPTIONAL

COUNSELLINGCounseling: It is a process that focuses

on helping a person understand theirissues and make effective decisionsaffecting their life.

Pre conception counseling : it is amethod that is based on the medical

theory that all women of child-bearing years should be pre-screenedfor health and risk potentials beforeattempting to become pregnant.


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Pre conception counseling

includesGeneral CareGenetic Counseling

-Aneuploidy Risk-Steps of counseling

Preconception Assessment,

counseling & support- Specificissues


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GENERAL CARE-:

Identification of high risk factors forpregnancy.Counseling for patient with badpregnancy history.

Risk from the environment.DietFolic acid

Body weightExerciseSmoking


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Cont

Alcohol use Medication review

Illicit drug use Cervical screening Chronic diseases

Infections


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GENETIC COUNSELING

Genetic counseling is theprocess of:

evaluating family history

and medical recordsordering genetic testevaluating the result of thisinvestigation helpingparents understand andreach decisions about whatto do next.


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Cont

CYSTIC FIBROSIS -CaucasiansBETA-THALASSEMIAALPHA-THALASSEMIASICKLE CEL DISEASEDowns Syndrome


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Cont

Offer genetic counseling to at-riskcouples

Testing includes carrier screeningand available antenatal diagnosticmodalities

Review possible options/mayconsider neonatal consultation


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ANEUPLOIDY RISK

Risk of any type of aneuploidyincreases with maternal age

Offer genetics consultation

Important to obtain familypedigree


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Cont

It has three steps -:1) PERSONAL INTERVIEW-: To

gather information aboutfamily, pedigree chart, mode ofinheritence, then initialdiagnosis is confirmed.

2)2ndAPPOINMENT-: Test ofother family members , andclarifies out come.


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Cont

LAST INTERACTIVE PHASE-:After having intervention

option for having child shouldgiven to the proband. If thecouple is not convinced thesecond session is repeated untilthe proband get convinced.


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Preconception Assessment,

Counselling, and Support Social Support Stress

Quality of Relationships Abuse and Violence


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LIMITATIONS OF

PRECONCEPTIONALCOUNSELLING

Lack of public awareness

Late consultations with doctorUnplanned pregnancies


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THE WOMANS ROLE

A woman may need to adjust certainaspects of her health & well beingwhich are in her control. In addition,she may need to discontinue certainherbs or over-the-counter medicationsas recommended by the physician.Many physicians will alsorecommend pre-natal vitamins beforea woman actually conceives in orderto boost her overall health.


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ROLE OF NURSE

Nurses have aresponsibility to involvethemselves in providing

preconception care toindividual women andfamily.

Nurse should work as

advocates to create healthy,supportive communities forwomen and men in thechild bearing age.


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Cont

Nurses should enterinto a collaborativepartnership with the

couples, enablingthem to examine theirown health and itsinfluence on the

health of baby


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Cont

Nurses role is to provide accurateinformation; translate couplesdecision making process; and offerthem and refer them to relevantservices when appropriate.

Community health nurse often work

closely with other communityleaders, including teachers andreligious leaders in the pre-conceptioncounseling and care.


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ROLE OF PRECONCEPTIONAL

COUNSELORS Practitioners providing routine

health maintenance for reproductive-aged women have the best

opportunity to provide preventivecounseling. Gynecologists, internists, familypractitioners, and pediatricians can

do so at annual examination. According to survey conducted on

1995 almost 95% of women reportedatleast


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Cont

One could affect a future pregnancy. These included Medical or

reproductive problem (52%), Family

history of geneticdiseases(50%),Increasing risk ofcontracting HIV(30%), Increased riskof contracting hepatitis B(25%), Druguse(25%), Alcohol use(17%),

Nutritional risk(54%). Basic pre-conceptional advice and

can be provided by primary careprovider.


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Cont

Medical record should be obtainedand reviewed.

Counselors should be knowledgeableabout relevant diseases, priorsurgery, reproductive disorders, or

genetic conditions.

The practitioners who isuncomfortable providing counselingshould refer the women or couple to acounselor with special exercise.


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Conclusion

Thorough history takingComplete physical exam

Necessary consultationsCounselingInstruct on accurate menstrual

history and on contraceptionNecessary laboratory evaluation


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Cont

Adequate preconceptioncounseling can decrease risk ofpregnancy complicationsEducation can lead to healthy

habits and realistic expectationsCan lead to more efficient and less

costly pregnancy care


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Every Woman, Every Time

Preconception health promotion iswellness for life


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Discussions/Questions


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THANK

YOU

pre-conceptional counselling and pre-conceptional care2

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